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Los Angeles Times
02-05-2025
- Health
- Los Angeles Times
Why Osteoporosis Isn't Just a Senior Problem Anymore
Osteoporosis is called the 'silent thief' because it quietly eats away at bone strength over time—until a fracture reveals the damage. Other risk factors like lifestyle and medical conditions also contribute to osteoporosis. This affects people across the lifespan from children with genetic bone disorders to adults with hormonal shifts and chronic inflammation. Despite being so common, osteoporosis is often misunderstood, undertreated or ignored. But new science is changing that, giving us new insights into how bones weaken, how to catch it early and how to protect skeletal health for life. At its core Osteoporosis is a disease of bone imbalance. Normally our bones are constantly renewing themselves—old tissue gets broken down and new tissue replaces it. But when this balance tips either by losing too much bone or making too little bones become porous, brittle and prone to break. As bone loss occurs individuals may lose bone mass and increase the risk of fractures. According to Aging Clinical and Experimental Research (2021) this imbalance can come from a variety of factors including hormonal changes (menopause), aging and even immune dysfunction [1]. These changes affect how cells within the bone operate and tip the scale towards bone loss. Imbalances in certain hormones can also significantly impact bone health. Children aren't immune either. Disorders like osteogenesis imperfecta or chronic malnutrition can cause pediatric osteoporosis. As stated in Seminars in Musculoskeletal Radiology (2021) when bone growth is disrupted in early life—during rapid growth spurts or due to genetic factors—the result is lifelong fragility [2]. Family history is another risk factor as individuals with a family history of osteoporosis are more likely to experience bone loss. Osteoporosis is a medical condition that requires a licensed physician for proper diagnosis and treatment. Routine screenings as recommended by the U.S. Preventive Services Task Force are essential for osteoporosis diagnosed early. Almost everyone is at risk of developing osteoporosis due to aging and lifestyle choices. Here's where things get even more interesting: bone health isn't just about calcium and exercise. The immune system and gut microbiome are also involved. A 2020 EXCLI Journal review states that chronic inflammation and microbial imbalances can weaken bones—linking osteoporosis to broader systemic issues like autoimmune diseases and gut disorders [3]. Chronic inflammation plays a big role in many osteoporosis cases. Conditions like rheumatoid arthritis accelerate bone loss not just because of the disease itself but because of the inflammatory chemicals involved. These substances called cytokines disrupt the delicate balance of bone remodeling. Nature Reviews Drug Discovery (2012) says pro-inflammatory cytokines can increase bone destruction and shut down new bone formation [8]. Another often overlooked factor is bone quality. We focus on bone mineral density (BMD) but that only tells part of the story. A person can have normal BMD and still fracture due to poor bone microarchitecture. In 2021 Instructional Course Lectures stated that bone strength also depends on its internal structure—like how well the collagen and mineral components are arranged [4]. Think of it like two buildings made of the same materials but one will collapse faster if the internal framework is weak. Bones are living tissue undergoing continuous remodeling where old bone is broken down and replaced with new bone. The gold standard for diagnosing osteoporosis is the DEXA (dual-energy X-ray absorptiometry) scan which measures bone mineral density. A bone density test is essential for identifying the disease early. But diagnosis goes beyond numbers. Clinicians look at a person's risk factors for osteoporosis: age, gender, history of fractures, medications like steroids and chronic illnesses. According to Lancet (2019) secondary fracture prevention programs such as Fracture Liaison Services (FLS) are proving to be essential tools in identifying patients who may have osteoporosis but were never formally diagnosed—especially after their first fracture [10]. These services help close the gap between injury and intervention so patients get the care they need before another break occurs. Healthcare providers diagnose osteoporosis during routine screenings following guidelines from the U.S. Preventive Services Task Force. Osteoporosis treatment isn't just about pills—it's a lifelong approach to treating osteoporosis. Preventive measures like being active, eating a diet rich in calcium and vitamin D, not smoking and being at a healthy weight can go a long way. Weight-bearing exercises like walking, jogging and dancing are essential for building and maintaining strong bones. Taking a calcium supplement can help you meet your daily recommended intake especially if your dietary calcium is inadequate. But for those already affected, medications play a big role. Endocrinology and Metabolism Clinics (2015) stressed the importance of patient education saying that understanding the condition improves long-term treatment outcome [5]. Here are the common treatment options: To prevent osteoporosis you need to adopt a healthy lifestyle that includes a balanced diet and regular physical activity. P&T Journal (2018) noted that while these treatments are effective doctors must also consider cost, side effects and the patient's ability to adhere to the regimen when choosing a therapy plan [9]. Preventing fractures involves maintaining bone health through adequate calcium and vitamin D intake, prescribed medications and avoiding falls. Weight-bearing exercise is particularly beneficial in preventing bone loss and reducing the risk of fractures as we age. Treating osteoporosis effectively requires a balanced approach that includes medication, diet and exercise. Children with bone disorders need a more tailored approach. Their bones are still growing so doctors must be cautious with medications that might affect that process. A 2023 Current Osteoporosis Reports article emphasized the need for nuanced care strategies in kids with developmental delays or skeletal disorders [7]. The future of osteoporosis care is moving beyond one-size-fits-all approaches. As the 2023 Endocrinology and Metabolism Clinics review said, age, genetics, environment and lifestyle all play a role in determining bone health risk and treatment plan [6]. Achieving peak bone mass by 30 is key to reducing the risk of osteoporosis later in life. Maintaining bone mass over time is also crucial to reducing osteoporosis-related fractures. That means looking at bone health from childhood to old age. Early-life interventions especially for children with chronic illnesses can build more bone for the future. In older adults, early screening and multidisciplinary care including primary care, endocrinology and geriatrics can prevent devastating fractures that often lead to disability or loss of independence. Strategies to keep bones strong are a balanced diet rich in calcium and vitamin D and regular physical activity. Keeping bones healthy is weight-bearing exercise and preventing falls. Osteoporosis isn't just a disease of aging—it's a lifelong concern that requires early awareness, proactive prevention and tailored treatment especially for those at high risk and increased risk. By understanding the complex interplay of inflammation, bone quality and individual risk factors we're moving towards more effective care for every stage of life. Osteoporosis risk is influenced by many medical conditions and lifestyle choices so preventive measures are key. The science is clear: strong bones start with strong strategies and the earlier we act the better the outcome. [1] Barnsley, J., Buckland, G., Chan, P. E., Ong, A., Ramos, A. S., Baxter, M., Laskou, F., Dennison, E. M., Cooper, C., & Patel, H. P. (2021). Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people. Aging clinical and experimental research, 33(4), 759–773. [2] Testini, V., Eusebi, L., Tupputi, U., Carpagnano, F. A., Bartelli, F., & Guglielmi, G. (2021). Metabolic Bone Diseases in the Pediatric Population. Seminars in musculoskeletal radiology, 25(1), 94–104. [3] Föger-Samwald, U., Dovjak, P., Azizi-Semrad, U., Kerschan-Schindl, K., & Pietschmann, P. (2020). Osteoporosis: Pathophysiology and therapeutic options. EXCLI journal, 19, 1017–1037. [4] Dimar, J. R., Lane, J. M., Lehman, R. A., Jr, & Anderson, P. A. (2021). The Basics of Bone Physiology, Healing, and Osteoporosis. Instructional course lectures, 70, 527–536. [5] Lupsa, B. C., & Insogna, K. (2015). Bone Health and Osteoporosis. Endocrinology and metabolism clinics of North America, 44(3), 517–530. [6] Khandelwal, S., & Lane, N. E. (2023). Osteoporosis: Review of Etiology, Mechanisms, and Approach to Management in the Aging Population. Endocrinology and metabolism clinics of North America, 52(2), 259–275. [7] Raimann, A., Misof, B. M., Fratzl, P., & Fratzl-Zelman, N. (2023). Bone Material Properties in Bone Diseases Affecting Children. Current osteoporosis reports, 21(6), 787–805. [8] Redlich, K., & Smolen, J. S. (2012). Inflammatory bone loss: pathogenesis and therapeutic intervention. Nature reviews. Drug discovery, 11(3), 234–250. [9] Tu, K. N., Lie, J. D., Wan, C. K. V., Cameron, M., Austel, A. G., Nguyen, J. K., Van, K., & Hyun, D. (2018). Osteoporosis: A Review of Treatment Options. P & T : a peer-reviewed journal for formulary management, 43(2), 92–104. [10] Compston, J. E., McClung, M. R., & Leslie, W. D. (2019). Osteoporosis. Lancet (London, England), 393(10169), 364–376.
Forbes
26-03-2025
- Business
- Forbes
How Harnessing AI Can Transform Clinical Trials
Kamya Elawadhi is Chief Client Officer at Doceree . getty Clinical trials are an essential part of medical breakthroughs that help patients, but getting them off the ground and running them is often fraught with challenges. Specifically, qualification, activation, compliance and data monitoring and analysis can be complex, resource-intensive, time-consuming and expensive for pharmaceutical researchers. Consider this: Many clinical trials aren't able to even move past the recruitment and enrollment stage. According to Deloitte , a 'study on the benefits of virtual randomized clinical trials shows that more than 80% of in-person studies are delayed because of insufficient patient recruitment, while 80% of research sites fail to meet enrollment goals.' Once past the initial stage, other problems can arise. As noted in Nature Reviews Drug Discovery , one report assessed 7,455 drug development programs that went 'through the clinic between 2006 and 2015.' The researchers 'found that the probability of success was 63% in Phase I trials, 31% in Phase II trials, 58% in Phase III trials and 85% during the regulatory review process, for an overall success rate of 9.6%.' However, pharmaceutical companies can leverage AI to overcome challenges and streamline the clinical trial landscape. There are several key ways AI can help pharmaceutical companies address common challenges associated with clinical trials. For one, AI can be used to improve patient recruitment. When patients have doctor's visits, physicians capture critical data, such as concerns discussed and any medications that were prescribed, via electronic health records (EHRs). Currently, pharmaceutical researchers depend on physicians to pinpoint who might qualify for a clinical trial. In the hectic day-to-day of providing patient care, physicians may not remember which patients qualify and which don't. That's where AI can step in. AI can sift through structured and unstructured EHR data, such as diagnoses, lab results, prescriptions and physicians' notes, to match patients with trial criteria more efficiently than physicians having to rely on memory alone. From there, AI can be used to activate patient engagement. Through an app or an EHR system, physicians can receive notes that particular patients qualify or are strong candidates for given clinical trials—and can also get guidance on the details they need to share with patients, such as the purpose of the trial and next steps for getting involved (if the patient expresses interest in doing so). Once patients enroll, researchers can use AI to monitor compliance and analyze feedback during trials. For instance, if patients have to take a medication twice a day, they can get push notifications on their phones, reminding them when it's time to take their medication and instructing them to indicate when they've finished taking the medication. AI can keep track of which patients have completed the task and which haven't—and then message them appropriately. Additionally, patients can input their feedback, such as their adverse side effects, into an app or system. AI can then analyze that feedback, uncovering common threads and outliers to present to researchers. Researchers won't have to spend hours combing through the data themselves. Instead, they can gain a quick understanding of the risks and benefits of their drugs and adjust accordingly. The Risks Of Using AI In Clinical Trials AI can streamline clinical trials, but it's not without risks. AI should be used as an assistive tool for clinical trials, not a replacement for human expertise and judgment. While AI tools offer value, they aren't infallible. Human oversight is crucial. Researchers and physicians should proactively review the recommendations that AI tools make. For example, an AI tool might indicate that a patient is a good fit for a clinical trial, but a physician might decide that, say, based on a contraindication, they shouldn't participate in the trial. Additionally, compliance with HIPAA and other privacy regulations is imperative. Pharmaceutical companies must thoroughly evaluate prospective AI vendors and review their data policies to ensure compliance The Benefits Of A Crawl, Walk, Run Approach In AI Implementation Leaders of pharmaceutical companies who are considering implementing AI for clinical trials should consider a crawl, walk, run approach—starting with specific use cases in their clinical trials, rather than fully overhauling their approaches at once. Rolling out AI for clinical trials is a major organizational change. And given the stakes in clinical trials, pharmaceutical leaders should be extra cautious. By implementing AI in stages, pharmaceutical leaders can pace themselves and their teams, get a stronger sense of what is effective for patients and adjust as needed. By streamlining clinical trials, particularly the clinical matching process, pharmaceutical companies can save time and money—and allocate that time and money to research and development. Ultimately, using AI in clinical trials can help drugs get launched sooner, helping more patients. Forbes Business Council is the foremost growth and networking organization for business owners and leaders. Do I qualify?
